Sepsis talk 2017

Slides from the talk are located here here. Sorry they are black/white, it was the only way to reduce the file size enough to include it here. Full-color pictures of important figures are in the blogs below. More information about these topics is below, arranged in parallel to the structure of the talk:

After the talk we had a panel discussion including Drs. William Charish (Surgery/CC) and Lyle Gerety (Anesthesia/CC). It was a great discussion, with a few salient points as below:

Peripheral pressors

Charish: Evidence consists of case reports, we may be over-reacting to the possible harm.

Gerety: In the operating room we use peripheral phenylephrine like water.

Me: For crashing patient, any peripheral catecholamine vasopressor is OK until stabilized (often with central line placement). For patient remaining on peripheral pressors for longer periods of time (e.g. 6-48hr) I only use phenylephrine or epinephrine.

Gerety: In addition to risk of extravasation, need to also consider risk of central line insertion.

Resuscitation targets

Surprising amount of agreement about this, I thought, although there doesn't seem to be any magical resuscitation target. Ultimately I think we're all similarly befuddled.

Lactate isn't a great resuscitation target but we will continue to trend this because it's required by CMS.

Rising lactate meaningless if patient is on epinephrine infusion (may be a harbinger of improvement rather than deterioration).

Rising lactate in patient not on epinephrine is sign of badness, not a blind trigger for fluid administration. Evaluate patient globally: are we using wrong antibiotic? Missing surgical source control? Wrong diagnosis altogether?